Becker's has reported on four health systems that have agreed to settle improper billing allegations since Jan. 5:
1. Hershey, Pa.-based Penn State Health agreed to pay more than $11.7 to resolve allegations that it submitted annual wellness visit services that violated Medicare rules.
The health system voluntarily disclosed that, between December 2015 and November 2022, it submitted claims for annual wellness visit services that were not supported by the medical record. After discovering a discrepancy with documentation requirements, Penn State Health's compliance office took corrective action and disclosed the matter to the U.S. Attorney's Office.
2. Pomona Valley Hospital Medical Center in Pomona, Calif., agreed to pay more than $2 million to resolve allegations it overbilled the state's Medicaid program for prescription medications.
From 2016 through September 2021, Pomona Valley improperly charged higher "usual and customary" costs, rather than lower "actual acquisition costs," as required under the 340B Drug Pricing Program, according to the Justice Department.
3. New York City-based NewYork-Presbyterian Hospital agreed to pay $801,000 to resolve allegations that two radiology practices improperly billed federal healthcare programs for images used in image-guided radiation therapy treatments.
Between 2012 and 2018, the two practices — which are no longer operating — allegedly billed for images that were either not reviewed or were not timely in a timely manner, according to the release. An investigation also found that one of the practices submitted upcoded claims in some instances.
4. Tampa, Fla.-based Moffitt Cancer Center agreed to pay more than $19.5 million to resolve civil liability after self-disclosing that it improperly billed federal healthcare programs for clinical trial costs.
The settlement resolves Moffitt's civil liability for claims that it submitted to Medicare and other federal healthcare programs from 2014 to 2020 for services that were not reimbursable under CMS' rules governing reimbursement for clinical care provided in connection with clinical research trials, according to the Justice Department.